In Chókwe, in the Mozambique province of Gaza, the rains from Cyclone Freddy culminated in floods that forced the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) to stop activities for a week while moving the staff, the seriously ill, and the equipment to safer places.
The storm resulted in widespread power outages, destruction to infrastructure and housing as well as a devastating loss of lives, caused by both the storm itself and the incapacitated medical systems. The resilience of governments and international partners prevented countless deaths, but more needs to be done.
“This process has negatively affected us to the extent that we have reached the point of ceasing care at the main health facilities and transferring all services to the resettlement center in Chiaquelane,” says EGPAF’s Chókwe District coordinator, Aleixo Salgado. This will affect the future, because patients are left without medical care and have no access to medication as they did not reach the resettlement centre,” says Aleixo Salgado.
The damage to infrastructure, equipment, logistics and other areas may not be able to be repaired until time passes.
“I was affected psychologically because I had move my belongings and keep my file in order.” Salgado recalls that there were colleagues who transported kids in difficult circumstances.
Climate Change: A Foreboding Future
Cyclone Freddy ripped through South-Eastern Africa. It landed in Mozambique on February 23-24, and again on March 11th. Heavy rains in this area are not uncommon, but Cyclone Freddy’s path was unusual. It landed twice, first on February 23 and 24, and then again on March 11. The World Meteorological Organization claims that Cyclone Freddy, after being named a tropical storm for 34 days and crossing the South Indian Ocean and traveling more than 8,000 km, is possibly the “longest-lasting tropical cyclone recorded.”
Climate change is likely to cause unpredictable weather events like Cyclone Freddy. According to the United Nations, climate change refers to “the long-term changes in temperatures and weather patterns” such as increased rainfall and unpredictable cyclones. Recent studies have shown a link between climate change, and the severity and frequency of cyclones Ana (2020), Batsirai (2022) and Idai (2017). The Cyclone sparked a call for investment in health systems to prepare local and global communities for more cyclones.
“You know that with climate change, Chókwe, Mozambique will always be affected. Salgado says that as EGPAF we need to plan for the future. “This is crucial.”
These investments have paid off for some EGPAF sites. This is a positive sign of what proactive action can accomplish. While facilities in Malawi that still used paper-based filing lost everything, those who had digitized their medical records and stored them in a “Data Lake” were able to protect critical medical data from the cyclone.
Charles Fodya (Project Director, Health Information Systems EGPAF-Malawi) says: “The Data Lake has been proven to be the resilience core for the whole Health Information System.” “All lost records are due to the washing away of servers, paper, etc. “All lost records due to washed away servers, papers, etc.
Inhambane (Mozambique): HIV Treatment and Basic Health Services are under threat.
In Vilankulos & Inhassoro Mozambique wind speeds have reached over 120 km/hr. Heavy rains are threatening the basic infrastructure of roads and electricity, preventing access to health care.
Edmundo Galiza Matos Jr., District administrator, says that the Rural Hospital in Vilankulos had its roof and trees fall. “The Quewene Health Center and the Pambarra residence of nursing technicians are also affected by the flooding.”
According to an emergency survey conducted by the Provincial Directorate of Health in the province, 20 health facilities have suffered damage. Orlando Noreno said the EGAPF regional coordinator of care and treatment, Orlando Noreno added that electric current interruptions are frequent throughout the entire region and that “the road leading to Mabote Health Center” is impassable. Some colleagues were sheltered in the Mussengue Health Center because of flooding at their homes.
The Morrumbene Health Center is now facing a new obstacle to providing continuous care. This comes on top of the roof leaks in the Youth and Adolescent Friendly Health Services section. Isaias Mauluve is the EGPAF focal point in charge of care and treatments at the Morrumbene Health Center. He said that while some medication was delivered the week prior, ABC+3TC (600/300), a first-line HIV medication for children and adolescents, was missing. Re-stocking is expected to be delayed due to the storm damage. It can be devastating to children with HIV. Gaps in treatment can lead to HIV becoming drug-resistant and allowing the virus resurge.
The Nhachengue Health Center has enough antiretrovirals and other drugs to treat the patients. The health center is missing the 600/300 ABC+3tc regime and 50mg DTG. (A first-line HIV treatment regimen for adults). We have zero stock,” said Massinga Regional Coordinator, Irene Menete.
Gaza and Mozambique: Health Workers Start the Road to Recovery
What happened to Suabira Paulo of the Maternal and Child Health and Prevention of Mother-to-Child HIV Transmission Mobile Focal Point was surreal. She was shocked to see her possessions being damaged by the floods. She was terrified when she saw the river overflowing because she hadn’t seen it before. She had to spend the nights in the dark because of the lack of electricity. And as they say, “opportunity is what makes the thief.” She was terrified because thieves took advantage to break in and steal things from the victims of the floods.
“First, I was affected because I had to leave my residence and leave my place of work as I am not from Guijá,” said Suabira. “It was difficult to see so many houses destroyed, and the agricultural fields submerged under water. The fact that there was nothing recovered was evident. The next few months are going to be very difficult for everyone. “Food will be scarce and the cost will rise,” said she.
EGPAF not only provided emotional and administrative support but also logistical help to the teams in moving them into safe areas. Everyone was included. The coordination was affected by the departures of district officers and members. EGPAF was asked by the Provincial Directorate of Health to continue providing support for certain health facilities as well as the resettlement centre. EGPAF formed two technical teams to support the resettlement centres, each headed by an advisor.
The teams returned to work on 7th March after the end of the crisis. However, Suabira is concerned that there may still be problems because some areas have not yet been drained. This could affect the efficiency of service delivery as patients are focused on rebuilding their homes and recovering from the losses they suffered.
“We’re back and recovering. I’m already recovered, but traumatized,” said coordinator Salgado.
Malawi: Digital Health Investments Pay Off
Malawi’s healthcare facilities also suffered serious losses.
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We lost some equipment due to flooding. We lost everything in other hospitals where flooding was severe. We were able save movable gadgets in some facilities (like J2 terminals or Laptops. Fodya says that they lost the power and network cables, which were soaked in flood water. “Some of the servers were damaged by roof leaks caused by the heavy rains. And we lost inverters from lightning that came along with cyclone.
The recent digitization in many healthcare facilities of medical records is a glimmer of hope.
Fodya says, “In health centers that have lost everything, the Central Data Repository has been critical in recovering medical records and continuing healthcare access for HIV patients.” We are printing Emastercards from the data lakes for each patient and sharing them with the health centers. Printouts are being used to replace hardware while we mobilise resources.
The project to transition to digital records at first seemed like a difficult and unnecessary task. However, the Cyclone highlighted the many benefits of such a program. The facilities that were already digital could simply reprint their health records to continue service delivery. Facilities that were not yet in transition now need to start all over again, which is a major drain on the human resources needed to deal with the intensified and existing health threats. This includes re-starting treatment for clients who lost theirs during the storm and dealing with the ongoing cholera epidemic that was exacerbated due to the heavy flooding caused by cyclone Freddy.
Fodya, while proud of the work his team has done, sees more room for improvement: “The next step is to migrate our data architecture to a central data repository system from a decentralized one. This will reduce data loss between the data on the server local and the data on central server. We need to collect data dumps more frequently in health care facilities.